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Objective: To explore the safety and effectiveness of Taylor spatial frame (TSF) in the treatment of medial compartmental osteoarthritis (MCOA) of the knee and the adjustment of the lower extremity force line at the same time. Methods: The clinical data of 30 patients with MCOA who underwent high tibial osteotomy (HTO) between October 2016 and April 2017 were retrospectively analyzed. According to the different fixation methods, they were divided into external fixation group (TSF external fixation, 16 cases) and internal fixation group (locking steel plate internal fixation, 14 cases). There was no significant difference between the two groups in gender, age, side, disease duration, mechanical femur tibia angle (MFTA), and other general data ( P>0.05). The operation time and intraoperative blood loss of the two groups were recorded and compared; MFTA was used to evaluate the recovery of the lower extremity force line at last follow-up; Hospital for Special Surgery (HSS) score was used to evaluate the clinical effecacy before operation and at 2 weeks, 1 month, and 3 months after operation. Results: The operation time and intraoperative blood loss of external fixation group were significantly less than those of internal fixation group ( P0.05). Conclusion: TSF has unique advantages in HTO treatment of MCOA patients and correction of lower extremity force line, such as shorter operation time, less bleeding, firm fixation, and less complications. It can accurately adjust the lower extremity force line after operation and has good effectiveness. It is an effective and safe fixation method.
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BACKGROUND: Most of the domestic and foreign literatures reported the mid-term and long-term effects of the unicompartmental knee arthroplasty of the mobile bearing, but few reported the mid-term and long-term clinical effects of the unicompartmental knee arthroplasty of the fixed bearing. Simultaneously, most of the studies did not analyze the knee function recovery and the lower limb force line change at different time points after the fixed bearing unicompartmental knee arthroplasty, and also ignored the follow-up of the patients’ self-feeling after the unicompartmental knee arthroplasty. OBJECTIVE: To explore the mid-term clinical effect of fixed bearing unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of knee joint and to observe the change of force line of lower limbs. METHODS: From January 2014 to January 2015, a retrospective analysis was made of the data of 66 patients diagnosed as osteoarthritis of the medial compartment of the knee in the Department of Arthritis, Foshan Hospital of Traditional Chinese Medicine. According to the inclusion and exclusion criteria, 66 patients were included, including 18 males and 48 females, aged (62.36±16.33) years. The American Knee Society knee score and the hospital for special surgery knee score were used to assess the knee function before and 1, 3 and 5 years after the operation. Visual analogue scale score was utilized to evaluate the severity of knee. Forgotten joint score was used to assess the subjective feeling of prosthesis after unicompartmental knee arthroplasty. Hip-knee-ankle angle and tibiofemoral angle were measured using X-ray films before treatment and at follow-up to evaluate the force line of weight-bearing lower limbs. RESULTS AND CONCLUSION: (1) The postoperative follow-up time was 5-6 years, averagely 5.5 years. The incision healed in the first stage. There was no early complication such as joint infection or lower extremity deep vein thrombosis, and there was no prosthesis loosening, dislocation or other diseases of the contralateral compartment and patellofemoral joint. (2) The American Knee Society knee score clinical score, American Knee Society knee score function score, hospital for special surgery knee score, knee motion range and visual analogue scale score were lower at 1, 3 and 5 years after operation than those before treatment (P 0.05). (3) Forgotten joint score was higher at 3 and 5 years after treatment than that at 1 year after treatment (P 0.05). (4) Hip-knee-ankle angle and tibiofemoral angle were significantly improved after treatment in all patients compared with those before treatment (P 0.05). (5) The results show that the mid-term clinical effect of unicompartmental knee arthroplasty with fixed bearing is satisfactory, and the degree of self-prosthesis is high. After treatment, the force line of lower limbs was improved, and there was no significant change in the 5-year follow-up.
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BACKGROUND: The traditional surgical treatment of proximal tibial fractures has extensive dissection of the fracture site, and affects local blood circulation, increases the incidence of delayed union and nonunion. In recent years, the rising minimally invasive internal fixation system can protect the local soft tissue and blood circulation to the maximum extent, and provide better conditions for fracture healing. The application of new spreader also solves the problems of stability and durability of traditional manual traction reduction, and the combination of the two is gradually concerned. OBJECTIVE: To explore the effect of a new minimally invasive spreader assisted reduction and less invasive stabilization system for the treatment of proximal tibial fractures. METHODS: Twenty-two patients with proximal tibial fractures treated from May 2016 to October 2019 were studied and randomly assigned to control group and observation group (n=11 per group). Patients in the control group were treated with conventional manipulative reduction and conventional incision plate internal fixation. Patients in the observation group were treated with a new minimally invasive spreader assisted reduction and less invasive stabilization system. This study was approved by the Ethics Committee of Fifth Hospital, Guangzhou Medical University. RESULTS AND CONCLUSION: Compared with the control group, Rasmussen knee function score was better in the observation group at the last follow-up. Intraoperative blood loss, operation time, length of hospital stay, and weight-bearing time in the observation group were better than those in the control group. Postoperative complications such as joint limitation and delayed fracture healing were less in the observation group than in the control group. However, the healing time was not statistically significant between the two groups. Moreover, infection of the incision and loosening and fracture of the internal fixator were not statistically significant between the two groups. These indicated that the application of a new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures can reduce surgical reduction time and local soft tissue damage, which is beneficial to early functional exercise and can reduce postoperative complications.
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The principle and technical background of EOS imaging system are introduced. Combining with the publicity of this technology and the existing literature reports, it is known that low dose EOS technology can reduce radiation dose by 5 to 10 times in the course of examination, and micro dose EOS can even reduce radiation dose by 45 times. The image quality is only high or low; the system has EOS 2D and 3D workstations, which can help clinicians to measure and evaluate coronal and sagittal force lines of lower limbs easily. The tilt and torsion of limbs can be measured three-dimensional after three-dimensional model reconstruction in the three-dimensional workstation. Using these results, preoperative evaluation can be carried out. It is helpful for clinicians to evaluate and improve preoperative planning and post-operative measurement and evaluation of surgical effect. In terms of measurement accuracy, a large number of literatures reported that the accuracy of EOS 2D measurement is comparable to that of general radiology measurement, while the accuracy of EOS 3D reconstruction measurement is comparable to that of CT and MRI. Based on the technical characteristics and advantages of EOS, this paper reviews the literature reports and research progress of EOS in evaluating the accuracy of lower limb alignment.
Subject(s)
Imaging, Three-Dimensional , Lower Extremity , Mechanical Phenomena , Tomography, X-Ray ComputedABSTRACT
Internal fixator is usually adopted in the treatment of bone fractures. In order to achieve anatomical reduction and effective fixation of fractures, the placement of internal fixators should comply with the biology force line of the bone and adapt to the specific anatomical morphological characteristics of the cortical bone. In order to investigate the distribution characteristics and formation regularity of biology force line and cortical thickness of human bone, three-dimensional model of proximal femur is established by using three-dimensional reconstruction technique in this paper. The normal physiological stress distribution of proximal femur is obtained by finite element analysis under three kinds of behavior conditions: one-legged stance, abduction and adduction. The structural topology optimization method is applied to simulate the cortex of the proximal femur under the combined action of three kinds of behavior conditions, and the anatomic morphological characteristics of the proximal femur are compared. The distribution trend of biology force line of proximal femur and the characteristics of cortex are analyzed. The results show that the biology force lines of bone structure and the morphological characteristics of cortex depend on the load of human activities. The distribution trend of biology force line is related to the direction of trabecular bone and the ridge trend and firmness of cortex when bone is loaded physiologically. The proposed analytical method provides a solution to determine the biology force line of bone and the distribution characteristics of cortex. The conclusions obtained may guide the reasonable placement of internal fixator components of fracture.
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Objective: To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods: The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups ( P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Results: Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group ( P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups ( χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups ( χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups ( χ2=0.520, P=0.471). Conclusion: The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.
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Este artículo se inscribe en el contexto de las reformas educativas contemporáneas y caracteriza cómo se está configurando el campo de la rectoría oficial escolar en Colombia a partir de las relaciones de poder que se generan entre el rector o rectora y las dimensiones macropolítica y micropolítica de las instituciones educativas. Los resultados muestran cómo el campo de la rectoría está fuertemente regulado por las normas y políticas educativas nacionales y la recontextualización que se hace de éstas en los escenarios macropolíticos locales. El campo del rector o rectora se configura a través de tres líneas de fuerza de dominio que cambian la orientación de la rectoría, afectan su función y generan cambios en sus relaciones: la primera hala al rector o rectora hacia el entorno en búsqueda de recursos, proyectos y relaciones con el gobierno local; la segunda hala al rector o rectora hacia la promoción de la democratización de la institución educativa y el disciplinamiento de los maestros y maestras; la tercera se orienta hacia la rendición de cuentas. Concluimos que la reconfiguración del campo del rector o rectora se da en un contexto socialmente problematizado y signado por amplias expectativas sobre el papel de la escuela y los rectores y rectoras. La labor directiva está marcada por un sesgo altamente administrativo, una orientación hacia el disciplinamiento de los maestros y maestras, y la rendición de cuentas. En medio de restricciones, los rectores y rectoras ensayan estrategias de negociación, y promueven acciones para lograr cumplir con los objetivos institucionales, con las demandas de la comunidad escolar y con las expectativas de su rol.
Este artigo fica no contexto das reformas educativas contemporâneas e caracteriza como se configura o campo da reitoria oficial escolar na Colômbia a partir das relações de poder que se geram entre o reitor e as dimensões macropolítica e micropolítica das instituições educativas. Os resultados indicam como o campo da reitoria está regulado fortemente pelas normas, políticas educativas nacionais e pela sua re-contextualização nos cenários macropoliticos locais. O campo do reitor configura-se através de três linhas de força de domínio que alteram a orientação da reitoria, afetam sua função e geram mudanças nas suas relações. A primeira impulsiona o reitor para o meio na busca de recursos, projetos e relações como o governo local; a segunda impulsiona o reitor para a promoção da democratização da instituição educativa e para o disciplinamento dos professores e das professoras; a terceira orienta-se para a apresentação de relatórios. O artigo conclui que a reconfiguração do campo do reitor se apresenta num contexto socialmente problematizado e caracterizado por expectativas amplas sobre o papel da escola e dos reitores e reitoras. A função diretiva está marcada por um preconceito altamente administrativo, uma orientação para o disciplinamento dos professores e das professoras, como também para a apresentação de relatórios. No meio de restrições, os reitores e as reitoras ensaiam estratégias de negociação e promovem ações para satisfazer os objetivos institucionais, as demandas da comunidade escolar e as expectativas do seu papel.
This article belongs in the context of contemporary school reforms and characterizes how the Colombian school principalship is being configured from the power relations generated between the principal and the macropolitical and micropolitical dimensions in educational institutions. The results show how the field of principalship is heavily regulated by national educational norms and policies and by their corresponding recontextualization in the local macropolitical scenarios. The principalship field is configured through three domain force lines that change the principalship orientation, affect its function and generate changes in their relations. The first force induces the principal towards the search for resources, projects and their relations; the second induces the principal towards the promotion of the democratization of the educational institution and to disciplining both male and females teachers; and the third refers to reporting management activities. The conclusion states that the reconfiguration of the principal's field takes place in context that is socially problematized and marked by wide expectations about the role of schools and by both male and female principals. The directive function is widely marked by a highly administrative bias, an orientation towards the disciplining of teachers and towards the reporting of management activities. In a world of restrictions, the principals try new negotiation strategies and promote actions aiming at meeting institutional objectives, along with the demands from the school and the expectations resulting from their roles.